A BILL to direct the Department of Medical Assistance Services to submit state plan amendments to the Centers for Medicare and Medicaid Services to seek to modify the program rules for consumer-directed services available through certain Medicaid waivers.
HB470 directs the Department of Medical Assistance Services (DMAS) to seek federal approval to change the rules for consumer-directed services under certain Virginia Medicaid home- and community-based services waivers. The bill would allow the person receiving services to serve as the employer of record for their own care, and to designate another person to carry out some or all of those employer duties when the recipient cannot do so or cannot direct their own care.
The bill also requires DMAS, in seeking this authority, to ensure that the employer identification number (EIN) is assigned to the service recipient rather than transferred to another person, except in limited circumstances such as when the recipient is a minor, cannot use the existing EIN for tax purposes, or is otherwise deemed ineligible by DMAS through rulemaking. DMAS would also be allowed to limit how often a recipient may change the designated person performing employer-of-record duties to no more than twice per calendar year.
If enacted and approved by the Centers for Medicare and Medicaid Services, the bill would affect the administration of Medicaid consumer-directed personal care and related waiver services in Virginia by expanding flexibility for participants and their families or support networks. It would require DMAS to pursue state plan or 1915(c) waiver amendments under Titles XIX and XXI of the Social Security Act, potentially changing how employer-of-record responsibilities are assigned and managed for waiver participants. The bill would primarily affect Medicaid waiver recipients, their designated representatives, and DMAS program administration, while also implicating tax and payroll-related handling of EINs.
The available legislative history suggests generally favorable support, though not unanimous. The bill was continued to the next session in Finance and Appropriations on a 12-3 vote, indicating that a majority of the committee supported the measure but some members had reservations or preferred delay. No committee transcript is provided, so the specific arguments for or against the bill are not available from the record here.
The main points of contention likely center on administrative control, federal approval, and the handling of employer-of-record authority and EIN assignment. Supporters appear to favor giving Medicaid waiver participants more autonomy and flexibility in directing their own care, especially when they cannot personally manage employer duties. Potential concerns include whether the proposed changes are workable under federal Medicaid rules, how DMAS would verify eligibility for exceptions, and whether limiting changes to the designated representative to twice per year could be too restrictive for some families or too loose for program oversight.